What Do You See As Your Main Strengths and Weaknesses?(Please Bullet Point)

What Do You See As Your Main Strengths and Weaknesses?(Please Bullet Point)

Eligibility Check
If you would like to apply to join the Achievers’ Network Programme, it is important that you meet the following requirements BEFORE you complete this application form. Please circle
I am able to attend the selection day on Saturday 9th September 2017 / Yes / No
I am able to attend the Residential Training weekend on 29thSept – 1stOct 2017
& the four compulsory Training Days. (Saturday’s 6thJan, 3th March, 28th April30th June 2018) / Yes / No
I have read the description of commitment required and able to tick all boxes / Yes / No
Please tell us about you:
Your Name:
Your Address:
Your Postcode: / Your Borough / District:
Your Landline Number: / Date of birth:
Your Mobile Number: / Age:
Your email address:
Education/Occupation
e.g. Secondary School, College, University, Employed, Unemployed & Job Seeking, Volunteering Only, Other
Name of school/youth organisation who referred you to this programme:
Application Questions
  1. Are you an ....(please tick the relevant box) To apply you must have one of these.

Achievement Award Winner
Speak Out Finalist/Winner
Step into Dance participant
  1. What do you see as your main strengths and weaknesses?(please bullet point)

Strengths / Weaknesses
  1. What would you like to work on to improve?

  1. Why do you think you are a potential leader?

You could give some examples of how you have motivated others, influenced change or made a difference in your community.
  1. How do you think the Achievers’ Network will help you to achieve more in life:

It is very important to us that you gain from being part of the Achievers’ Network. Please tell us how you feel taking part in the project will enable you to get more out of life. How do you think the experience and opportunities provided will change you or affect you in the future?Tell us how you think becoming a Network Member will help develop you as a person, will it help your confidence or your ability to help others?
  1. Referee

Please give us the details of someone who can act as a referee for you (they must be an adult who works with you such as a school teacher, social worker, community leader, youth worker etc but must NOT be a member of your family:
Referee Name:
Referee’s Address:
Postcode: / Email:
Landline Telephone No: / Mobile No:
Their relationship to you?
7. Declaration & Signatures
“I confirm that the details given in this application are correct.”
Applicant’s Signature / Date:
PLEASE NOTE if you are under18 you must get permission from a parent/guardian to participate
“I have read the details of this programme and agree to my son/daughter/ward to participate in a selection daySaturday 9th September 2017, a residential weekend on 29thSept to 1st Oct 2017 4 additional compulsorytraining daysSaturdays 6th Jan, 3th March, 28th April30th June 2018”
(If you can’t commit to all these dates please do not apply)
(All training days are funded by JPF)
Parent/Guardian’s Name
Parent/Guardian’s Signature
Parent/ Guardian’s Contact number
Equalities and Monitoring

  1. Are you Male or Female
  1. What ethnic background would you describe yourself as?



  1. Do you have a disability or any special needs that you feel JPF should be aware of in order to ensure you can participate fully in the programme?

Please be aware that all information is supplied in confidence to the Jack Petchey Foundation and will not be used outside of the Achievers’ Network.

Please ensure that this Application Form has been signed and send either by post or email:

The Jack Petchey Foundation, Dockmaster House, 1 Hertsmere Road, London, E14 8JJ

~ Email: ~ Telephone Number: 020 8252 8000

Circ: JP/Directors/KH/Steering GrpMay 2017OpMan AN005

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